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Communications to the Editor |

Changing Patterns in Asbestos-Induced Lung Disease FREE TO VIEW

Paul De Vuyst, MD, PhD; Pierre Alain Gevenois, MD, PhD; Alain Van Muylem, PhD; Jean Claude Yernault, MD, PhD, FCCP
Author and Funding Information

Erasme Hospital, Brussels, Belgium

Correspondence to: Paul De Vuyst, MD, PhD, Erasme Hospital, Chest and Radiology Departments, 808 Route de Lennik, Brussels, Belgium 1070; e-mail: pdevuyst@ulb.ac.be



Chest. 2004;126(3):999. doi:10.1378/chest.126.3.999
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To the Editor:

Ohar et al (February 2004)1 recently reported radiographic and functional results obtained in a large group of 3,327 asbestos-exposed workers. These authors concluded that asbestos-related disease is today characterized by “low” International Labor Office (ILO) scores (ie, < 1/1), and a normal or obstructive pattern of pulmonary function.

From an imaging point of view, most individuals (ie, approximately 80% of the study group) had so-called low ILO scores, including grades of 0/0 and 0/1, and among these individuals one half (ie, approximately 46%) even had no pleural abnormalities. As the superiority of thin-section CT scanning over radiography has been extensively demonstrated in patients with chronic diffuse infiltrative lung disease,2small opacities should be considered more carefully as a reflection of asbestos-related disease unless thin-section CT scans had been performed. In addition, radiographs were assessed by one reader only instead of several independent readers, as recommended.3In this study group, subjects with “high” ILO scores were older and smoked more than subjects with low ILO scores. This is not surprising, as both factors influence the profusion of small irregular opacities, even in subjects who have not been exposed to asbestos.4

From a functional point of view, patterns of lung function were defined as “normal, restriction, obstruction, or mixed.” The reference equations were not given, but the lower limit for normal values at 80% predicted, regardless of a patient’s gender, age, and height, is not consistent with all published reference equations for lung volumes.56 Ohar et al1 defined the restrictive ventilatory defect as an FVC that is lower than normal values but not, as recommended, by a total lung capacity that is lower than normal values. More importantly, the use of an FEV1/FVC ratio of < 70% of normal values as the only criterion of obstruction did not take into account the normal decrease of this ratio with aging.,78 The lower limit of normal FEV1/FVC ratio is indeed very close to 65% at 65 years. These limitations might have resulted in the misclassification of individuals into function categories. The same assumption was made in the Global Initiative for Chronic Obstructive Lung Disease guidelines,9 which resulted in the overdiagnosis of COPD in elderly subjects.10

Severe forms of asbestosis are now rarely observed, and the vast majority of asbestos-related lesions consists of pleural plaques and diffuse pleural thickening. Asbestosis and diffuse pleural thickening, if extensive, can be associated with a restrictive defect, but the study by Ohar et al1 does not show any evidence that these lesions could lead to an obstructive defect that is usually caused by longstanding smoking.

Ohar, J, Sterling, DA, Bleecker, E, et al (2004) Changing patterns in asbestos-induced lung disease.Chest125,744-753. [CrossRef] [PubMed]
 
Grenier, P, Valeyre, D, Cluzel, P, et al Chronic diffuse interstitial lung disease: diagnostic value of chest radiography and high-resolution CT.Radiology1991;179,123-132. [PubMed]
 
Obuchowski, NA How many observers are needed in clinical studies of medical imaging?AJR Am J Roentgenol2004;182,867-869. [PubMed]
 
Dick, JA, Morgan, WKC, Muir, DFG, et al The significance of irregular opacities on the chest roentgenogram.Chest1992;102,251-260. [CrossRef] [PubMed]
 
American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies.Am Rev Respir Dis1991;144,1202-1218. [CrossRef] [PubMed]
 
Quanjer, PH, Tammeling, GJ, Cotes, JE, et al Lung volumes and forced ventilatory flows.Eur Respir J1993;6(suppl),5-40
 
Hankinson, JL, Odencrantz, JR, Fedan, KB Spirometric reference values from a sample of the general U.S. population.Am J Respir Crit Care Med1999;159,179-187. [PubMed]
 
Falaschetti, E, Laiho, J, Primatesta, P, et al Prediction equations for normal and low lung function from the Health Survey for England.Eur Respir J2004;23,456-463. [CrossRef] [PubMed]
 
Pauwels, R, Buist, SA, Calverley, PM, et al Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.Am J Respir Crit Care Med2001;163,1265-1276
 
Hardie, JA, Buist, SA, Vollmer, WM, et al Risk of over-diagnosis of COPD in asymptomatic elderly never- smokers.Eur Respir J2002;20,1117-1122. [CrossRef] [PubMed]
 

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References

Ohar, J, Sterling, DA, Bleecker, E, et al (2004) Changing patterns in asbestos-induced lung disease.Chest125,744-753. [CrossRef] [PubMed]
 
Grenier, P, Valeyre, D, Cluzel, P, et al Chronic diffuse interstitial lung disease: diagnostic value of chest radiography and high-resolution CT.Radiology1991;179,123-132. [PubMed]
 
Obuchowski, NA How many observers are needed in clinical studies of medical imaging?AJR Am J Roentgenol2004;182,867-869. [PubMed]
 
Dick, JA, Morgan, WKC, Muir, DFG, et al The significance of irregular opacities on the chest roentgenogram.Chest1992;102,251-260. [CrossRef] [PubMed]
 
American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies.Am Rev Respir Dis1991;144,1202-1218. [CrossRef] [PubMed]
 
Quanjer, PH, Tammeling, GJ, Cotes, JE, et al Lung volumes and forced ventilatory flows.Eur Respir J1993;6(suppl),5-40
 
Hankinson, JL, Odencrantz, JR, Fedan, KB Spirometric reference values from a sample of the general U.S. population.Am J Respir Crit Care Med1999;159,179-187. [PubMed]
 
Falaschetti, E, Laiho, J, Primatesta, P, et al Prediction equations for normal and low lung function from the Health Survey for England.Eur Respir J2004;23,456-463. [CrossRef] [PubMed]
 
Pauwels, R, Buist, SA, Calverley, PM, et al Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.Am J Respir Crit Care Med2001;163,1265-1276
 
Hardie, JA, Buist, SA, Vollmer, WM, et al Risk of over-diagnosis of COPD in asymptomatic elderly never- smokers.Eur Respir J2002;20,1117-1122. [CrossRef] [PubMed]
 
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